Managing Diabetic Foot Ulcers: Pharmacotherapy for Wound Healing

Dixon, Danielle; Edmonds, Michael

doi:10.1007/s40265-020-01415-8

Cited by 110 publications

(77 citation statements)

References 132 publications

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“…Deep FUs can involve full thickness of the skin, muscle, tendons, and bones. [40][41][42][43][44] FUs are common in people with diabetes and individuals with compromised blood circulation. 43 Despite advanced health care and pharmacotherapy techniques that are widely available, prevalence of FU has not changed in the past two decades.…”

Section: Foot Ulcersmentioning

confidence: 99%

“…Bacteria rapidly colonize in open skin wounds after burn injury [81][82][83][84] or surgical incisions. 40,[85][86][87][88] Microorganisms colonizing these wounds are typically the patient's normal flora or may be transferred through contact with contaminated external contact such as water, fomites, or the soiled hands of health care workers. 86,87 Gram-positive bacteria such as Staphylococcus aureus and Enterococcus spp.…”

Section: Infectionmentioning

confidence: 99%

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Human Wound and Its Burden: Updated 2020 Compendium of Estimates

Sen

2021

Advances in Wound Care

466

333

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Significance: Chronic wounds impact the quality of life (QoL) of nearly 2.5% of the total population in the United States and the management of wounds has a significant economic impact on health care. Given the aging population, the continued threat of diabetes and obesity worldwide, and the persistent problem of infection, it is expected that chronic wounds will continue to be a substantial clinical, social, and economic challenge. In 2020, the coronavirus disease (COVID) pandemic dramatically disrupted health care worldwide, including wound care. A chronic nonhealing wound (CNHW) is typically correlated with comorbidities such as diabetes, vascular deficits, hypertension, and chronic kidney disease. These risk factors make persons with CNHW at high risk for severe, sometimes lethal outcomes if infected with severe acute respiratory syndrome coronavirus 2 (pathogen causing COVID-19). The COVID-19 pandemic has impacted several aspects of the wound care continuum, including compliance with wound care visits, prompting alternative approaches (use of telemedicine and creation of videos to help with wound dressing changes among others), and encouraging a do-it-yourself wound dressing protocol and use of homemade remedies/substitutions. Recent Advances: There is a developing interest in understanding how the social determinants of health impact the QoL and outcomes of wound care patients. Furthermore, addressing wound care in the light of the COVID-19 pandemic has highlighted the importance of telemedicine options in the continuum of care. Future Directions: The economic, clinical, and social impact of wounds continues to rise and requires appropriate investment and a structured approach to wound care, education, and related research.

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Section: Foot Ulcersmentioning

confidence: 99%

Section: Infectionmentioning

confidence: 99%

Human Wound and Its Burden: Updated 2020 Compendium of Estimates

Sen

2021

Advances in Wound Care

466

333

View full text Add to dashboard Cite

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“…Most of these patients receive the standard care, which involves assessment of the wound, regular wound dressing changes, offloading, antibiotics if infected, and perhaps debridement to remove necrotic or infected tissue [1,[5][6][7]. Some patients receive more advanced (and costly) therapies that are designed to help improve healing, including cell-based therapies such as Dermagraft ® , a human fibroblast-derived dermal substrate designed to build up the granulation tissue, or Regranex, which is a platelet-derived growth factor therapy designed to attract cells to the wound [8][9][10]. However, many of these wounds still fail to heal and, if more severe tissue damage or an infection is not stemmed, then amputation is generally required [1,11].…”

Section: There Is a Clinical And Economic Need For Better Wound Therapiesmentioning

confidence: 99%

Skin Wound Healing: Normal Macrophage Function and Macrophage Dysfunction in Diabetic Wounds

et al. 2021

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Macrophages play a prominent role in wound healing. In the early stages, they promote inflammation and remove pathogens, wound debris, and cells that have apoptosed. Later in the repair process, they dampen inflammation and secrete factors that regulate the proliferation, differentiation, and migration of keratinocytes, fibroblasts, and endothelial cells, leading to neovascularisation and wound closure. The macrophages that coordinate this repair process are complex: they originate from different sources and have distinct phenotypes with diverse functions that act at various times in the repair process. Macrophages in individuals with diabetes are altered, displaying hyperresponsiveness to inflammatory stimulants and increased secretion of pro-inflammatory cytokines. They also have a reduced ability to phagocytose pathogens and efferocytose cells that have undergone apoptosis. This leads to a reduced capacity to remove pathogens and, as efferocytosis is a trigger for their phenotypic switch, it reduces the number of M2 reparative macrophages in the wound. This can lead to diabetic foot ulcers (DFUs) forming and contributes to their increased risk of not healing and becoming infected, and potentially, amputation. Understanding macrophage dysregulation in DFUs and how these cells might be altered, along with the associated inflammation, will ultimately allow for better therapies that might complement current treatment and increase DFU’s healing rates.

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“…The Word Health Organization and International Diabetes Federation define chronic wound diabetes complications as diabetic foot, resulting in ulcers within the soft tissue due to a combination of neuropathy, peripheral vascular disease (ischaemia), and hyperglycaemia [ 2 ]. The pillar of treatment for these complications is addressing the extrinsic factors of repeated trauma, ischaemia and infection, and optimizing glycaemic control [ 3 ]. The intrinsic factors have been actively researched for the past three decades, including the molecular research of impaired healing in the diabetic wound, and in any case, this is not completely understood [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The pillar of treatment for these complications is addressing the extrinsic factors of repeated trauma, ischaemia and infection, and optimizing glycaemic control [ 3 ]. The intrinsic factors have been actively researched for the past three decades, including the molecular research of impaired healing in the diabetic wound, and in any case, this is not completely understood [ 3 ]. One of the key problems is that the term ‘soft tissues’ includes many different tissues, such as muscle, tendons, ligaments, fat, fibrous tissue, lymph and blood vessels, fasciae, and synovial membranes.…”

Section: Introductionmentioning

confidence: 99%

Diabetic Foot: The Role of Fasciae, a Narrative Review

Pirri

Fede

Pirri

et al. 2021

Biology

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Wound healing is an intricate, dynamic process, in which various elements such as hyperglycemia, neuropathy, blood supply, matrix turnover, wound contraction, and the microbiome all have a role in this “out of tune” diabetic complex symphony, particularly noticeable in the complications of diabetic foot. Recently it was demonstrated that the fasciae have a crucial role in proprioception, muscular force transmission, skin vascularization and tropism, and wound healing. Indeed, the fasciae are a dynamic multifaceted meshwork of connective tissue comprised of diverse cells settled down in the extracellular matrix and nervous fibers; each constituent plays a particular role in the fasciae adapting in various ways to the diverse stimuli. This review intends to deepen the discussion on the possible fascial role in diabetic wounds. In diabetes, the thickening of collagen, the fragmentation of elastic fibers, and the changes in glycosaminoglycans, in particular hyaluronan, leads to changes in the stiffness, gliding, and the distribution of force transmission in the fasciae, with cascading repercussions at the cellular and molecular levels, consequently feeding a vicious pathophysiological circle. A clear scientific perception of fascial role from microscopic and macroscopic points of view can facilitate the identification of appropriate treatment strategies for wounds in diabetes and create new perspectives of treatment.

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Managing Diabetic Foot Ulcers: Pharmacotherapy for Wound Healing

Cited by 110 publications

References 132 publications

Human Wound and Its Burden: Updated 2020 Compendium of Estimates

Human Wound and Its Burden: Updated 2020 Compendium of Estimates

Skin Wound Healing: Normal Macrophage Function and Macrophage Dysfunction in Diabetic Wounds

Diabetic Foot: The Role of Fasciae, a Narrative Review

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